A Journal of Clinical Dentistry-Heal Talk

2

Authors: Dr Abhijeet Bhasin Dr Maggi Soni

The posterior maxilla presents several challenges in rehabilitation to the implant dentist . Implant dentistry has become an excellent treatment modality since its inception into the modern era of dentistry. When patients present with deficient alveolar ridges, it could jeopardize the application of implant dentistry . thedimensional alterations of the residual ridge as well as the pneumatization of the maxillary sinus occurring after tooth loss may lead to vertical and transversal bone deficiencies significantly limiting the insertion of implants of desired length and diameter The procedure of choice to restore this anatomic deficiency is maxillary sinus floor lift up. The purpose of this case report is to bring forward such technique which prevents perforation of sinus lining during implant placement by doing the sinus lifting with indirect approach through alveolar crest .

2

Authors: Dr. Sanju Malik1 , Dr. Manu Rathee2 , Dr. Prachi Jain3, Dr. Maqbul Alam4

Resorption of mandible is a chronic, progressive, irreversible biomechanical disease leading to loss of vertical dimension, loss of sulcular depth and decreased lower facial height. Residual ridge resorption becomes a very big challenge for a clinician during the fabrication of a complete denture. It’s difficult for the patient to adapt to the mandibular denture and frequently result in complain of loose denture. Recording the neutral zone is an effective approach for construction of denture in highly resorbed ridges and in patient with history of denture instability. The neutral zone technique is not new by any means but it is certainly a valuable one. This case report describes neutral zone technique for a patient with an atropic mandibular ridge and neuromuscular incoordination

2

Authors: DR. MAYANK SINGHAL, DR. NIDHI SINGHAL, DR.NEELESH SONAL

Alveolar osteitis (AO) is a well known complication which occurs after dental extraction. It is commonly known as Dry Socket. Its incidence is approximately 3% for all routine extractions and can reach over 30% for impacted mandibular third molars1. One of the great clinical challenges since the first case was reported has been the in consistence and differences in the various definitions of dry socket and the criteria used for diagnosis. The treatment of AO includes conventional methods like use of antibiotics, medicated gauze, gel, rinse. It is associated with postoperative pain in and around the extraction site, accompanied by a partially or totally disintegrated blood clot within the alveolar socket, with or without halitosis2,3. The main objective of this article is to provide a better basis for clinical management of the condition. In addition, the need for identification and elimination of the risk factors as well as preventive and symptomatic management of the condition are discussed.

3

Authors: Dr Richa Singh1 ,Dr. Akanksha Rastogi2, Dr. Darakhshan Sultan3

Major advances in impression materials and their application have occurred during the last decade, with greater emphasis being placed on rubber impression materials than on dental compound, zinc oxide-eugenol, and agar and alginate. The increased use of agar impression material as a result of the development of the agar alginate combination technique should level off and continue at a modest level.

3

Authors: Vivek Singh, Anuradha.P, Sahana .S,Manu Narayan,Sugandha Agarwal, Shweta Singh

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4

Authors: Nitin Bhatnagar, Amrinder S.Tuli

Gingival recession is commonly defined as the apical migration of the gingival margin over the cement enamel junction (CEJ) with the exposure of the root surface. A variety of surgical techniques have been developed throughout the years and many studies have been carried out to evaluate these techniques with regard to their predictability and amount of root coverage achieved. The aim of the present study was to clinically evaluate the use of chorion membrane with tunneling technique approach in management of multiple gingival recession defects as a root coverage procedure. 6 months after the surgery there was 70 % root coverage which was achieved along with gain in attachment level, reduction in recession depth , recession width , gingival index score and sulcus bleeding index score. where as in plaque index score , pocket depth and width of keratinized tissue no significant changes were observed.

1

Authors: Dr. Mohd Rehan1, Dr. Manish Khatri2, Dr. Mansi Bansal3, Dr. Komal Puri4, Dr. Nisha Parveen5

A solitary, nodular lesions of the oral mucosa is a diagnostic dilemma to the dentist. The lesions that appear on the tongue, a soft muscular organ are distinct and even rarer with varied manifestations. Oral mucosa presents lesions of the tongue in all age groups that may range from a small nodular swelling and ulcer formation in an infant of a few days old to an ulcer or a lesion in a 70-year-old. The reason for the appearance of an ulcer may be trauma to the soft tissues however, etiology for such klesions range from presence of natal teeth in infants to presence of a sharp tooth in the older individuals.1

1

Authors: Dr. Geeta Singh Dr. Sujay Bhave Dr Santosh Kanna Dr. Abhigyan Manas

Impacted molars are more common in maxillary and mandibular third molars, whereas impacted central incisors and premolars are relatively rare. A case of horizontal impaction of maxillary central incisor and maxillary premolars is reported in this study, and the relevant literature are presented

2

Authors: Dr. Sandeep Singh Dr. Mohammad Aleemuddin

Nothing will ruin a beautiful smile more than having dark spaces between teeth . The search for improved dentofacial aesthetics persists in modern society. As we age and many other factors, sometimes unwelcome dark spaces appear between our teeth .Besides adding an older appearance to our simile, these dark spaces may also collect food debris and plaque. Also known as dental black triangles figure -1) the clinical terminology is gingival embrasures - they can be the result of bone loss , recession of the gum line, or movement of the teeth. Some people have naturally occurring gaps between their teeth called Diastema. Though not always unhealthy, gaps between the teeth are sometimes the source of embarrassment or low self-esteem, especially fo the young population

2

Authors: Dr. Derek Mahony

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3

Authors: Dr. Prashant Singh1, Dr.Nilesh Ranjan2, Dr. V.Shubhash3, Dr. Rohit Bahri4, Dr. Kunal Yadav5 , Dr. Ajay Kumar6

Radiographic imaging is an important diagnostic adjunct in the assessment of skeletal and dental relationship for the orthodontic patient. Cephalometric analysis is performed to determine deviations in the skeletal and dentoalveolar relationship by identifying specific landmarks on both hard and soft tissues to consecutively calculate the spatial and angular relationship between them. Three-dimensional (3D) imaging techniques are becoming increasingly popular and have opened new possibilities for orthodontic diagnosis and treatment assessment. Recently, cone-beam computed tomography (CBCT) have been developed specifically for the maxillofacial region and it has many applications. The clinical value of CBCT is to describe craniofacial anatomy accurately and provide comprehensive information regarding anatomical relationship and individual patient findings for improved diagnosis, treatment planning and prognosis determination. Maxillofacial applications of CBCT have been used for patients that need maxillofacial surgery and patients with impacted teeth or any kinds of asymmetry but the lack of 3D standard population norms have restricted CBCT from routine orthodontic use. This article focuses on various contemporary and future applications of CBCT technology in orthodontics.

3

Authors: 1. Dr. Rashmi Agarwal 2. Dr. Swati Gupta Dr. Subodh Shankar Natu 3. Dr. Sarita Seth 4. Dr. Rohie Jawarker

The Prosthodontics work always been considered as tedious, laborious and time consuming. But in the 21st century innovation in the field of machining and digitalization has made the work of prosthodontics much easier, simpler and faster. The most widely acceptable example of this technique has been used of CAD-CAM (computer aided design- computer aided machine). This concept also has had its share of deficiencies. The new concept of 3D –printing exhibits the potential to overcome these deficiencies and present itself at the fore front of prosthodontics art and science. 3D-printing employs an additive manufacturing process whereby products are built on a layer-by-layer basis, through a series of cross-sectional slices. 3D-printing can be used not only produce fixed partial dentures which may be both meta and ceramic based restorations(crown, inlays and onlays) but also complex restoration like removable partial denture and maxillofacial prosthesis. But still evidence base research is required to validate this revolutionary concept of technology.

4

Authors: Dr. Barkha Idnani Dr. Dipti Choksi Dr. Aditi Choksi

Radiographic examination is essential in diagnosis and treatment planning in dentistry. The interpretation of an image can be confounded by the anatomy of both the teeth and surrounding structures. The ability to assess an area of interest in 3-Dimension is beneficial for both novice and experienced clinicians. Cone Beam Volumetric Tomography also known as cone beam computed tomography, captures a cylindrical volume of data in one acquisition. The volume acquired by a CBVT is composed of voxels. A voxel is a 3-D pixel. As the data are captured in a volume, all the voxels are isotropic, which enables objects within the volume to be accurately measured in different directions. CBVT offers distinct advantages over conventional CT. These advantages include increased accuracy, higher resolution, scan-time reduction, and dose reduction. CBVT allows the clinician to view the tooth and pulpal structures in thin slices in all three anatomic planes: axial, sagittal, and coronal. This capability alone allows visualization of periapical pathology and root morphology previously impossible. This presentation will be containing its use for assessment of implants, for third molar extraction and orthodontic analysis. Along with its use in endodontics for Apical morphology and suspected lesions of endodontic origin, Root canal system morphology, Presurgical visualization, Suspected root fractures and trauma, Internal and external root resorption.

1

Authors: Dr. Naresh Sharma,Professor, Dept of Pedodontics & Preventive Dentistry, Manav Rachna Dental College, Faridabad. Delhi (NCR) Dr.Amit Mohan, Reader, Dept of Oral & Maxillofacial Surgery,Manav Rachna Dental College, Faridabad. Delhi (NCR)

Tooth decay is a widespread, infectious disease classically related to the interplay of biological, behavioral and socio-economic influences. It affects about 40–50% of adults in industrialized countries. It has been hypothesized that pregnancy could increase the risk of caries initiation or progression, by changes in saliva composition, repeated gastric reflux or less effective oral health care. However, given the relatively short time frame of pregnancy and the kinetics of dental caries progression, it is unlikely that tooth decay will develop from initial carious lesion to major tooth damage within this period.

1

Authors: Dr. Rohan Gupta1, Dr. Nandita Gogoi2

Many complications can arise during the routine delivery of dental care. These complications include adverse drug reactions, allergic reactions to dental materials, physical injury from instrument slippage or breakage and swallowing or aspirating foreign objects. The consequences of aspiration a foreign object or material can range from immediate obstruction of the airway to long lasting pulmonary complications.

2

Authors: Dr. Gaurav Gupta1, Dr. D.K. Gupta2, Dr. Neelja Gupta3, Dr. Priyanka Gupta4

Trigeminal neuralgia is a chronic condition which have a major impact on quality of life. There are few reports of trigeminal neuralgia in oriental populations. The objectives is to evaluate the patients diagnosed with idiopathic trigeminal neuralgia and to understand the disorder in the Indian populace.

2

Authors: Dr. Farrukh Faraz1, Dr. Shruti Tandon2, Dr. Arundeep Kaur Lamba3, Dr. Archita Datta4, Dr. Kanika Chowdhri5

The relationships among the different forms of aggressive periodontitis are not clear, and the way in which they progress with time remains unknown. Periodontal diseases in children occur in localized and generalized forms. In the current case report, four children belonging to a single family, suffering from an incisor molar pattern of periodontal disease, were examined. Preliminary investigations revealed no significant dental or medical history and systemic findings, other than a clinical presentation similar to Localized Aggressive Periodontitis (LAP). This maybe suggestive of familial aggregation of a recessive trait, in the consanguineous family, leading to periodontal disease.

2

Authors: Swati Srivastava1, Vandana A Pant2, Ashish Saini3, Suraj Pandey4, Pallavi Sharma5

Pain perception is a complex sensory experience and in most cases it is the fear of pain arising from surgical treatment which refrains patients from availing complete dental treatments. By providing adequate knowledge about the level of pain after various surgeries, clinicians would help their patients to have realistic expectations of their surgical procedures, which would enhance the rapport between the dentist and the patient and in turn increase patient compliance. In this study we evaluated 30 patients undergoing periodontal surgeries and the same number of patients undergoing implant surgeries. Patients' post-surgical pain perception was recorded using a numeric rating scale (NRS, 1-10). In this, the patient was asked to make three pain ratings, corresponding to current, best and worst pain experienced over the past 24 hours. The average of the three ratings was used to represent the patient's level of pain over the previous 24 hours. According to the rating provided, the pain perception was categorized into mild (1-3), moderate(4-6) and severe(7-10). Patients' were also enquired about the duration of the pain and swelling if encountered. The duration and dosages of the medication prescribed were also recorded

2

Authors: Dr. Roma Arubam1, Dr. Anshumali2, Dr. Bebineeta Ningthaojam3, Dr. Ajay Singh 4, Dr. Himanshu Gupta5

The risk of sports-related injuries is constantly present in various sporting activities. Dental injuries are the most common type of orofacial injury sustained during participation in sports with the increased popularity of contact sports and encouragement to participate at an early age, the role of the dental profession in relation to prevention of dental and other orofacial sporting injuries has become more important in view of this. The common orofacial related injuries include soft tissue injury and hard tissue injury- the teeth and facial bones, such as tooth intrusions, luxations, crown and/or root fractures, complete avulsions and dental-facial fractures. Any sport where the potential for dental trauma can exist should consider utilizing mouthguards as it may help to reduce the incidence of dental trauma

3

Authors: Dr. Sakshi Aggarwal1, Dr. Deepak Kumar Gupta2

There has been a rising trend in the number of patients seeking orthodontic care, especially among the adults. This drift towards adult orthodontics indicates increased social awareness among the general population about their esthetics. Further, this phenomenon has additionally been supported by the use of orthodontic aligners as they are esthetically superior choice for adult orthodontics which requires mild to moderate correction. Orthodontic aligners are made up of various thermoplastic materials e.g. Bioplast, Copyplast, Duran, Hardcast, Imprelon, Essix A+, Essix C+ and Invisalign.. Orthodontic aligners, namely Invisalign and others are associated with adverse effects which diverge from a local response to various types of systemic manifestations. In this article the adverse effects associated with aligners and their possible mechanisms are reviewed. The databases Google Scholar, Medline/OvidSP, Web-of-Science and BIOSIS search engines were searched. The search criteria used was adverse/ harmful/ deleterious effects of sequential aligners/ clear aligners/ aligners/ Invisalign system. The articles which laid emphasis on adverse effects of aligners and the possible mechanisms for such reactions were included. Some of the adverse effects include difficulty breathing, sore throat, swollen tongue, hives and itchiness, anaphylaxis, chest pain, cough, nausea, difficulty swallowing, blisters on tongue. The possible mechanisms for these adverse events are attributed to the composition/ products released by Invisalign/ sequential aligners, namely, Bisphenol A and polyurethane. The potential mechanism is due to the presence of isocyanates in polyurethane, which bind with proteins and other biomolecules forming haptens. These can sensitize the immune system leading to potential allergic responses.

4

Authors: Dr. Derek Mahony

Edward H. Angle dominated orthodontic armamentarium, diagnosis and treatment planning for almost a half century until Charles Tweed successfully challenged his mentor's nonextraction mantra. The ensuing diagnostic regimen used by Tweed, however, proved to have serious limitations and clearly resulted in the extraction of too many teeth. This caused a subsequent deterioration of soft tissue appearances of patients that neither they nor their doctors liked. This article will describe and illustrate how new expansion techniques differ qualitatively from those of Angle, and how these techniques offer patients and doctors less invasive and more comfortable therapies which do not jeopardize facial appearances.

1

Authors: Dr. Mohd Rehan1, Dr. Manish Khatri2, Dr. Mansi Bansal3, Dr. Nisha Parveen4

Impacted canines pose a functional as well as an esthetic concern in the patients as they provide a major support for the cheek. Surgical exposure of an impacted tooth is necessary to allow the orthodontist access to the unerupted tooth, in order to bring it into the dental arch and into alignment. This case reports the surgical removal of the soft tissue covering the maxillary impacted canine with diode laser

2

Authors: Dr. Rythm Kharbanda1, Dr. Pradeep Raghav2, Dr. Navna Gupta3

This is a case report of 25 year old female in which utility arch is used for deep bite correction which is the most efficient way of deep bite correction in adults and is a stable method also in adults.

2

Authors: Dr. Shivani Mathur1, Dr. Pradeep Raghav2, Dr. Ashutosh3, Dr. Preeti4

Class II malocclusion has a prevalence rate of 14.5% in North Indian population. The treatment of such malocclusions should aim at correcting the skeletal deficiency in order to achieve facial harmony. This case report is of a 14 year old female patient who reported in her late adolescence (CVMI 6) with a Class II skeletal pattern, retrognathic mandible and convex profile. She was treated with AdvanSync2, a molar-to-molar fixed functional appliance for a period of 10 months and showed tremendous improvement in her facial profile, eliminating the need of surgical intervention to achieve facial balance.

2

Authors: Gaurav Gupta1, Dr. D.K. Gupta2, Dr. Neelja Gupta3, Dr. Priyanka Gupta4

Giant cell tumor (GCT) of bone is a distinctive neoplasm characterized by abundance of multinucleated giant cells scattered throughout the stroma of mononuclear cells. Its importance lies in recognizing and differentiating the characteristic histology, which at times may mimic several other bone tumors and endocrine disorders ranging from locally aggressive giant cell granulomas to hyperparathyroidism to malignant tumors. The jaw bones account for less than 1% of this lesion. We present a rare case of GCT of the mandible which occurred in a 19-year-old male.

2

Authors: Dr. Anil K Tomer1, Dr. Ruchi Gupta2, Dr. Smita Sahni3, Dr. Shobhit Kumar Pyasi4

Perforation repair is a fairly common endodontic procedure. The purpose of this case report was to present a clinical case of perforation repair of mandibular first molar. A case was selected based on clinical and radiographic examination. The cases was retreated, repaired with light cure glass ionomer cement, and restored. Recalls were carried out after six months. Perforation repair was shown to be successful in this case. Light cure glass ionomer cement can be used as successful alternative to MTA for perforation repair in mandibular molar.

3

Authors: Dr. Anshul Chandra1, Dr. Vandana A Pant2, Dr. Ashish Saini3, Dr. Esha Banerjee4

Aim: To compare the efficacy of black coffee with chicory mouthwash and chlorhexidine gluconate mouthwash in prevention of gingivitis and plaque formation. Materials & Methods: A total of 30 randomly selected subjects visiting the department of periodontology,Babu BanarasiDas college of dental sciences, Lucknow, were considered for the study. The gingival index (GI) by Loe and Silness was recorded which was followed by Turesky-Gilmore- Glickman modification of Quigley Hein plaque index (TQHPI) at 0 and 15 days. Subjects in the age group of 25 to 35 years having fair and poor gingival index scores, were included in the study. Results: Results showed statistically significant reduction (p < 0.05) in mean gingival index (GI) inblack coffee with chicory mouthwash when compared with chlorhexidine gluconate. Significant difference in mean plaque index (PI) was seen when chlorhexidine mouthwash was compared with Coffea canephorea with chicory mouthwash. Conclusion: From the above observations, it can be concluded that chlorhexidine gluconate as well as black coffee with chicory mouthwash can be effectively used as an adjunct to mechanical plaque control methods in prevention of plaque and gingivitis. Coffea canephorea with chicory has been found to be more effective when antigingivitis property was considered.

3

Authors: Dr. Anil K Tomer1, Dr. Hysum Mushtaq2, Dr. Nitika Verma3, Dr. Akankshita Behera4 , Dr. Nitish Mittal5

Pulpal injury after tooth injury is not easy to accomplish, because of the infected pulp requires tooth extraction or root canal therapy. Recently, there has been increasing interest in applying the concept of tissue regeneration to endodontics. Tissue Engineering is the science of designing and manufacturing of new tissue to replace damaged ones. In the recent years, stem cell research has grown exponentially owning to the recognition that stem cell- based therapies have the potential to repair and restore the normal functional tissue. It is known that dental tissues are rich source of mesenchymal stem cells that are suitable for tissue engineering. The aim of the study was to review the potential use of different types of stem cells, most common growth factors and scaffolds used to control their differentiation.

1

Authors: Dr. Ashwani Kumar1, Dr. Anupam Nagpal 2, Dr. Bhuvan Nagpal 3

Chronic irritational factors like plaque, calculus, overhanging margins, trauma and dental appliances are the major causes for reactive hyperplastic growths seen in the oral cavity. This paper reports a case of irritation fibroma in a 40-year-old female in relation to gingiva of 12, 13, 14 region. Excisional biopsy was done and diagnosis of irritational fibroma was rendered on the basis of histopathological evaluation.

1

Authors: Dr. Anil K Tomer1, Dr. Panna Mangat2, Dr. Akankshita Behera3, Dr. Nitish Mittal4

In order to achieve a successful endodontic treatment, the clinician must aim to establish a proper diagnosis and an appropriate treatment planning. A thorough idea about the root canal variation and canal configuration is of utmost necessity. Often incomplete or inadequate shaping and cleaning, leads to poorly obturated canals, thus allowing the moisture to the canal space

2

Authors: Dr. Shoborose Tantray1, Dr. Seema Sharma2, Dr. Nazima Nasrullah3

The human microbiome plays a significant role in oral health. Oral health is result of mutualistic interaction between different inter and intra species in host.The microbiota plays an important role in human health from entraining immune system development and maintaining homeostasis to influencing autoimmune diseases and allergies.

2

Authors: Dr. Mayank Singhal1, Dr. Nidhi Singhal 2, Dr. Neelesh Sonal 3

Odontomas generally appear as small, solitary or multiple radio-opaque lesions found on routine radiographic examinations. Traditionally, odontomas have been classified as benign odontogenic tumors and are subdivided into complex or compound odontomas morphologically1`. Compound odontomas commonly occur in the incisor-canine region of the maxilla and complex odontomas are frequently located in the premolar and molar region of both jaws. Occasionally, odontoma may cause disturbances in the eruption of teeth such as impaction, delay eruption or retention of primary teeth2. In general, odontomas occur more often in the permanent dentition and there are very few reports of odontomas associated with third molar teeth in the literature. In this case report; odontoma with impacted maxillary third molar in a adult patient, which are very rarely diagnosed associated with impacted third molar teeth, is presented.

2

Authors: Dr. Khushtar Haider1, Dr. Binita Srivastava2

The nature of tooth enamel is of inherent interest to dental professionals. The current-day clinical practice of paediatric dentistry involves the prevention of enamel demineralization, promotion of enamel remineralization, restoration of cavitated enamel where demineralization has led to cavitation, vital bleaching of dental enamel that has become discolored, and diagnosis and treatment of developmental enamel malformations, which can be caused by environmental or genetic factors. On a daily basis, dental health providers make diagnostic and treatment decisions that are influenced by their understanding of tooth formation. Developmental enamel defects, presenting as enamel hypoplasia or opacities are caused by damage or disruption to the developing enamel organ as a result of inherited and acquired systemic conditions. The high prevalence of these defects in the dentition demonstrates the vulnerability of the teeth to changes in the pre- and postnatal environment. The presence of enamel hypoplasia increases the risk of primary teeth to early childhood caries and tooth wear as the defective enamel is thinner, more plaque retentive and less resistant to dissolution in acid compared to normal enamel. Enamel hypoplasia patients are susceptible to the restorative cycle of replacement restorations like any other patient, but start with a distinct disadvantage. This article“Aesthetic Treatment Approach for Enamel Hypoplasia – A Case Report”. demonstrates a minimally invasive, relatively simple and cost-effective option for the aesthetic correction of a case of hypoplastic enamel with layered composite veneers.

2

Authors: Dr. Mamta Kaushik1, Dr. Roshni Sharma2, Dr. Soujanya3, Dr. Neha Mehra4, Dr. Mohammad Aleemuddin5

Patented IPN technology is at the heart of ever-Stick fibers. Ever-Stick fiber bundles have up to 4000 individually silanated E-glass fibers that are fully impregnated with resin. This fusion of fibres and resin forms the exceptionally strong, aesthetic and user-friendly Interpenetrating Polymer Network (IPN). Ever-stick transparent glass fiber post is one of the esthetic post where it can be flexed and can be incorporated in the compromised coronal tooth structure to stabilize Corono-Radicular assembly

3

Authors: Dr. Bhuvan Nagpal1, Dr. Jyoti Nagpal2, Dr. Jyotsana Nagpal3, Dr. Aditya Garg4, Dr. Anuradha Garg5, Dr. Anupam Nagpal6

As a result of economic development in industrial, infrastructure, medical, information technology and agriculture sector in India in the past 20 years, the citizens have become more content, lavish and comfortable but this has also affected the environment badly because of tremendous increase in environmental pollution as the rate of waste generation is very high in India. Waste product which is infectious, hazardous, and sometimes radioactive and is generated during the various medical related activities such as diagnosis, treatment and immunization is known as biomedical waste. Today, biomedical waste management has become one of major issue of concern in India taking into account the rate of growth of population and rapid urbanization. This paper includes biomedical waste, its classification and various practices adopted for its management. Biomedical waste may be solid or liquid and is generated majorly from hospitals and laboratories. Biomedical waste include discarded blood samples, sharps, unwanted microbiological cultures, identifiable body parts other human or animal tissue, used bandages and dressings, discarded gloves, other medical supplies that may have been in contact with blood and body fluids, and laboratory waste that exhibits the similar characteristics. Biomedical waste is distinct from normal trash or general waste. Medical facilities also generate hazardous chemicals and radioactive materials. While such wastes are normally not infectious; but they require proper disposal. Disposal of this waste is also an environmental concern, as many medical wastes are classified as infectious and could potentially lead to the spread of infectious disease. Biomedical waste must be properly managed and disposed of to protect the environment, general public and workers, especially healthcare and sanitation workers who are at risk of exposure to biomedical waste as an occupational hazard. Steps in the management of biomedical waste include generation, accumulation, handling, storage, treatment, transport and disposal.

3

Authors: Dr. Malvika Panchal Sharma1, Dr. Binita Srivastava2, Dr. Nidhi Gupta3, Dr. Natasha Gambhir4, Dr. Rashi Singh5

Restoration of severely damaged anterior teeth of a young toddler who has suffered from multiple tooth loss due to rampant early childhood caries is the greatest challenge for a pediatric dentist. Premature loss of anterior teeth has a great impact on child's psychology and behavior whereas premature loss of posterior teeth causes space loss which can lead to malocclusion and functional disturbances too. The aim of this paper is to describe the rehabilitation of primary anterior and posterior teeth in a 4 yr old child using a fixed, esthetic and functional appliance: A modified Groper's Appliance. These appliances are considered to be elective and their placement is generally by wish of the parents.